The global response to tuberculosis has saved millions of lives; TB treatment saved 53 million lives between 2000 and 2016. Yet each year millions still suffer, and often die, from this preventable, treatable and curable disease.

We research and analyze responses to TB around the world, and we have seen the intersection between human rights and TB. Without a response to TB based in human rights – including moving rapidly to community-based care and improving the conditions in prisons – we believe that progress will remain fatally slow.

Many individuals and groups face a combination of risk factors for TB. Indigenous peoples, for instance, have TB incidence rates up to 270 times the non-indigenous population. Prisoners and detainees, migrants, miners, indigenous people, health workers, the homeless, children, people living with HIV, and drugs users are especially vulnerable.

TB and prisons

Prisons can be incubators of TB, places where TB spreads rapidly. Up to 25 percent of a country’s TB cases may be found in its prisons. This in turn can increase the burden of TB in communities, as former prisoners return to communities, and as visitors and prison staff circulate between communities and prisons.

TB, hospitalization, and community-based care

Beyond the issue of confinement in prisons, excessive isolation, such as in health care facilities, and punitive approaches to TB, such as imprisonment for non-adherence to TB medicine and laws effectively criminalizing people with TB, impede efforts in the fight against TB.

Confinement – or isolation, quarantine, detention and imprisonment – has been used in countries throughout modern history on grounds of “public health” to prevent the spread of infectious diseases, such as in the context of plague epidemics, yellow fever, cholera, leprosy, and more recently, SARS and MERS.

While perhaps well-intentioned and sometimes appropriate, in practice, the use of confinement too often leads to egregious rights violations through overly broad use of isolation or other confinement, especially when excessively lengthy.

The overuse and inappropriate use of confinement on public health grounds, helps drive TB. It not only unnecessarily restricts people’s liberty in violation of their human rights, but also is less effective than community-based treatment.
People may avoid seeking care because of the cost of hospitalization, including not being able to work. Meanwhile overstretched hospitals may be unable to care for all in need, leading to treatment delays.

The World Health Organization specifies that involuntary isolation should only be used as a method of last resort, in extremely rare circumstances, and never employed as punishment. Yet, contrary to WHO guidelines and other international human rights standards, the public health or criminal law practices of some countries allow for involuntary hospitalization or even imprisonment of people with TB, while some countries have laws that permit mandatory treatment.

To end TB as a public health threat by 2030, as envisioned by the United Nations’ Sustainable Development Goals, we believe countries should urgently change their laws and their practices to conform to both the right to health care and the most effective public health practices. That means ensuring everyone has access to comprehensive quality health services and ensuring everyone the nutrition, adequate housing, and other underlying determinants of health to which all people are entitled.

And in our view, countries must unite to end the era where confinement and punitive measures are routinely used as a response to TB. Instead, they should establish a new era, one marked by community-based care, informed by evidence and human rights-based approaches.

People collect water piped in from a mountain creek in Utuado, Puerto Rico on Oct. 14, 2017, in the aftermath of Hurricane Maria. Hundreds of thousands of Puerto Ricans were still without running water.
AP Photo/Ramon Espinosa